Abstract
Various definitions are used to define metabolic syndrome in adolescents. This study aimed to compare, in terms of prevalence and differences, five frequently used definitions for this population: International Diabetes Federation, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP) modified by Cook, pediatric American Heart Association (AHA), World Health Organization, and Jolliffe and Janssen. A sample of 1004 adolescents (12.5–17.0 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study was considered. The components of the definitions (waist circumference/BMI, plasma lipids, glycemia, and blood pressure) were applied, and definitions were compared by using crosstabs, sensitivity, specificity, and kappa coefficient. The prevalence of metabolic syndrome varied from 1.6 to 3.8% depending on the used definitions. Crosstabs comparing the definitions showed the fewest cases being misclassified (having metabolic syndrome or not) between NCEP-ATP and AHA. Analyses for kappa coefficient, sensitivity, and specificity confirmed this finding.
Conclusion: The different definitions do not classify the same adolescents as having MS and prevalence varied between diagnostic methods. The modified NCEP-ATP and the AHA definitions were most analogous in defining subjects as having metabolic syndrome or not.
What is known? |
• Metabolic syndrome is not only a problem of adulthood but is already present in children and adolescents. |
• Several diagnostic methods are used to define metabolic syndrome in adolescents. |
What is new? |
• Comparing the most frequently used definitions of metabolic syndrome in adolescents showed that they do not indicate the same adolescents as having metabolic syndrome. |
• The modified National Cholesterol Education Program Adult Treatment Panel III and the pediatric American Heart Association definitions were most analogous in defining subjects as having metabolic syndrome or not. |
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Abbreviations
- AHA:
-
Pediatric American Heart Association
- cMetS:
-
Continuous metabolic syndrome score
- CVD:
-
Cardiovascular disease
- HDL:
-
High-density lipoprotein
- HELENA-CSS:
-
the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study
- HOMA:
-
Homeostasis Model Assessment
- IDF:
-
International Diabetes Federation
- MS:
-
Metabolic syndrome
- NCEP-ATP:
-
National Cholesterol Education Program Adult Treatment Panel III modified by Cook
- NHANES:
-
National Health and Nutrition Examination Survey
- TC:
-
Total cholesterol
- TG:
-
Triglycerides
- WHO:
-
World Health Organization
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Acknowledgements
The authors are grateful to all of the adolescents that took part in the HELENA study and to all researchers who set up the data for further analysis. Many thanks to Petra Pickert and Anke Carstensen for their contribution to laboratory work.
Author contributions
TV and ES performed the statistical analyses and drafted the manuscript. KV and IH launched the idea and supervised the full process of the manuscript development. CCS and FO performed extra statistical analyses and reviewed the manuscript. LAM coordinated the HELENA study. CB, MGG, FG, LB, DM, YM, MJG, KW, CL, JD, MA, AK, MJC, and SDH critically reviewed the manuscript. All authors approved the final version of the manuscript.
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The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). KV is financially supported by the Research Foundation Flanders (FWO). CCS is supported by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). FBO is supported by a grant from the Spanish Ministry of Science and Innovation (RYC-2011-09011).
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The authors declare that they have no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Communicated by Mario Bianchetti
*The authors of this paper take sole responsibility for its content. See Supplemental Material for a complete list of the HELENA project members.
Revisions received: 7 December 2016; 9 December 2016
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Vanlancker, T., Schaubroeck, E., Vyncke, K. et al. Comparison of definitions for the metabolic syndrome in adolescents. The HELENA study. Eur J Pediatr 176, 241–252 (2017). https://doi.org/10.1007/s00431-016-2831-6
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DOI: https://doi.org/10.1007/s00431-016-2831-6